You are consulted to evaluate a patient who presents to the oncology service. The patient is a 37-year-old woman with a history of leukemia. She completed her treatment regimen 1 month before her admission. During the past 3 weeks, she has been experiencing low-grade fever and a cough that is productive of mostly clear phlegm. On admission, a chest x-ray is obtained, and the patient is treated with broad-spectrum antibiotics for a presumed pneumonia. Blood and sputum cultures are negative for bacteria and fungi.

Flexible fiberoptic bronchoscopy.

Flexible fiberoptic bronchoscopy reveals left lower lobe bronchial erythema and minimal acute inflammation of the posterior segmental bronchus. Scanty secretions are present. Bronchial washings reveal many leukocytes and no bacteria. Cultures from the bronchoscopy specimen recover Aspergillus species. Further evaluation of the patient reveals a past history of recurrent chest infections. Repeat chest x-rays do not indicate improvement from the initial admission x-ray. The patient continues to have low-grade fever on broad-spectrum antibiotics.

The patient’s clinical scenario is consistent with that of a left lower lobe fungal infection with possible cavitation. The extent of radiographic lung disease prompts further diagnostic evaluation. Although there is no evidence of a lung abscess on the chest x-ray, computed tomography (CT) scans of the chest provide a better anatomic definition of the inflammatory process.